Provider Demographics
NPI:1871526400
Name:LUEVANO, ALFONSO (MD)
Entity type:Individual
Prefix:DR
First Name:ALFONSO
Middle Name:
Last Name:LUEVANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 278
Mailing Address - Street 2:
Mailing Address - City:CARRIZO SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78834-6278
Mailing Address - Country:US
Mailing Address - Phone:830-876-9458
Mailing Address - Fax:830-876-2411
Practice Address - Street 1:302 S 5TH ST
Practice Address - Street 2:
Practice Address - City:CARRIZO SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78834-3802
Practice Address - Country:US
Practice Address - Phone:830-876-9458
Practice Address - Fax:830-876-2411
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7622207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167639702Medicaid
TX0060MTOtherBLUE CROSS BLUE SHIELD
TX167639702Medicaid
TXP00269494Medicare PIN
TX0060MTOtherBLUE CROSS BLUE SHIELD